A study looking at how people with cancer of the larynx make decisions about treatment

Cancer type:

Head and neck cancers

Laryngeal cancer

Status:

Results

Phase:

Other

This study looked at how people with cancer of the voice box (larynx) make decisions about which treatment to have.

More about this trial

There are two main treatment options for cancer of the larynx (laryngeal cancer):

a combination of chemotherapy and radiotherapy at the same time (chemoradiation)
surgery to remove the voice box (laryngectomy)

These treatments can cause side effects that can change the way people speak or swallow. This can have a big impact on people’s quality of life. So deciding which treatment to have can be difficult.

Some people decide to have a treatment that may not work as well, but is likely to cause fewer side effects.

In this study the researchers spoke to people who had already had treatment for head and neck cancer, and had no signs of cancer. They also spoke to health care professionals (HCPs) involved in caring for people with head and neck cancer.

They explained the treatment, the possible side effects and how well they are likely to work. The research team asked the patients and HCPs to rate the treatment options and choose which outcome they thought would be best.

The aim of the study was to find out how treatment side effects and outcomes may affect a person’s decision about which treatment to have for a head and neck cancer.

Summary of results

The research team found patients and health care professionals sometimes think differently about what is important. And that it’s important to base treatment decisions on what patients think.

This study was open for people to join between 2013 and 2014, and the research team published the results in 2017.

About this study

The research team talked to 49 patients and 73 health care professionals, to see what they thought about the different treatment options for laryngeal cancer.

First, they explained the treatment options using videos, recordings and pictures.

Then they gave people 4 outcomes to rate from the best option to worst option. They were:

chemoradiation that had gone well
chemoradiation with some side effects
surgery that had gone well
surgery with some side effects

They then did an exercise for each of these options. They asked people to choose if they would prefer to live for a number of years with side effects from treatment, or to live for less time but with normal health.

The research team worked out a score called a utility value for each treatment option. This helps them assess how important quality of life is to people. There is more about this in the ‘results’ section below.

Results

The research team asked the people taking part which treatment they thought they’d prefer to have. It was similar for patients and health care professionals:

2 out of 3 people said chemoradiation
1 out of 3 people said surgery

Working out the utility value

Researchers looked at how much value people put on being healthy and having a good quality of life. This is called the utility value. It’s a way of assessing whether people would be willing, in theory, to live for less time but have a better quality of life during that time.

The utility value is a number between 0 and 1.

If the score is nearer 0, it means people feel the side effects and impact of treatment would greatly affect their quality of life. So they would be more prepared to live for less time, but with a better quality life.

If the score is nearer 1, they don’t feel the side effects or impact of treatment would have that much effect on their quality of life. So they wouldn’t be as prepared to live for less time, because the increase in quality of life would only be small.

The results showed that for each treatment option, the scores were a bit lower for patients than for health care professionals (HCPs). This means that the side effects and reduced quality of life have a bigger impact on people’s decision making than HCPs realise.

Utility scores for the different treatment options

Treatment Option	HCP	Patients
Chemoradiation that went well	0.77	0.73
Surgery that went well	0.69	0.67
Surgery with more side effects	0.51	0.46
Chemoradiation with more side effects	0.49	0.36

Preferred treatment

At the end of the process, the researchers asked people again which treatment they would prefer. They wanted to see if, after talking about it in more detail, anyone had changed their mind. They found that:

10 patients and 11 health care professionals changed from chemoradiation to surgery
8 patients but 0 health care professionals changed from surgery to chemoradiation

They asked people if they would change to the other treatment (the one they’d prefer not to have), if it meant they would live longer. Some people said they would not:

4 out of 73 health care professionals (5%)
15 out of 49 patients (31%)

Some people said they would change their mind to the other treatment. But only if it meant they would live, on average, an extra:

2.6 years (health care professionals)
2.8 years (patients)

Conclusion

The research team concluded the health care professionals and patients think about and value treatment options and side effects differently.

They recommend that decision making tools should include more information about what patients think is most important to them.

Where this information comes from

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item

) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.